Patient Guide approx. 8 min.

Periodontitis and Implants: What Patients Need to Know

Q: Can I get implants despite having periodontitis?

Yes — but only after complete periodontal treatment and a stability phase of 3–6 months. Active periodontitis is a relative contraindication for implants, not an absolute one. Once the inflammation is controlled, pocket depths have normalised, and the bone is stable, implants can be placed successfully. Digital diagnostics (CBCT, intraoral scanner) help determine the right timing.

Q: What is peri-implantitis and how does it differ from periodontitis?

Peri-implantitis is an inflammation of the tissue surrounding an implant — the implant equivalent of periodontitis. Like periodontitis, it is caused by bacteria and leads to bone loss. The difference: implants lack periodontal fibres that act as an early-warning system. Peri-implantitis can therefore progress more rapidly than periodontitis. Patients with a history of periodontitis have an elevated risk of developing peri-implantitis.

Q: How long do I need to wait after periodontitis treatment before receiving implants?

The waiting period depends on the severity of periodontitis and the success of treatment. As a general rule, a stability phase of 3–6 months is recommended, during which pocket depths are monitored and treatment outcomes are digitally documented. In cases of severe bone loss, additional bone grafting may be necessary, which requires further healing time.

Q: Which bacteria cause both periodontitis and peri-implantitis?

The main culprits are anaerobic gram-negative bacteria: Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia (the so-called 'red complex'), and Aggregatibacter actinomycetemcomitans. These bacteria can migrate from periodontal pockets onto implant surfaces — particularly in patients who have previously had periodontitis.

Q: What does 'periodontal rehabilitation' mean before implant placement?

Periodontal rehabilitation encompasses all measures necessary to control periodontitis: mechanical debridement (scaling and root planing), laser therapy if indicated, oral hygiene instruction, and regular monitoring. The goal is to bring all pocket depths below 4 mm and eliminate bleeding on probing. Only once this condition is stable should implant planning begin.

Why periodontal health is the prerequisite for successful implants — and how digital diagnostics determine the right moment.

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Contents of this guide

Periodontitis and implant – clinical illustration of the connection

The Connection Between Periodontitis and Implants

Periodontitis and implantology are closely interrelated — in both directions. On the one hand, untreated periodontitis is one of the most common contraindications for dental implants. On the other hand, a history of periodontitis increases the risk of peri-implantitis, the inflammatory condition around a placed implant.

The reason lies in biology: the bacteria that cause periodontitis — particularly Porphyromonas gingivalis and Treponema denticola — persist in the oral cavity and can migrate onto the surfaces of newly placed implants. Unlike natural teeth, implants lack periodontal fibres that serve as a mechanical barrier and early-warning system. This makes them more susceptible to bacterial colonisation.

Active Periodontitis

Relative contraindication — implants only after complete rehabilitation and a stability phase

Controlled Periodontitis

Implants possible — close supportive care (SPT every 3 months) is mandatory

Healthy Periodontium

Optimal starting condition — standard aftercare (SPT every 6 months) is sufficient

Risk Factors for Peri-implantitis

Not all patients with a history of periodontitis will develop peri-implantitis following implant placement. What matters is the combination of multiple risk factors, which should be systematically recorded before treatment planning begins.

Risk Factor	Clinical Relevance
History of Periodontitis	Elevated peri-implantitis risk due to persistent pathogenic bacterial strains in the remaining dentition
Smoking	Reduced blood circulation, impaired wound healing, 2–4 times increased risk of implant failure
Poorly Controlled Diabetes Mellitus	Compromised immune response, delayed osseointegration, increased susceptibility to infection
Poor Oral Hygiene	Biofilm accumulation on implant surfaces — the most important avoidable risk factor
Genetic Predisposition	IL-1 polymorphism: heightened inflammatory tendency, potentially more aggressive disease progression
Lack of Supportive Care (SPT)	Without regular professional cleaning, the risk of peri-implantitis increases significantly

Periodontal Rehabilitation Prior to Implant Placement

Before any implant planning in patients with a history of periodontitis, complete periodontal rehabilitation is mandatory. The goal: all pocket depths below 4 mm, no bleeding on probing (BoP < 10%), and stable bone. Only then is the timing for implants clinically justifiable.

Professional Dental Cleaning & Oral Hygiene Instruction

Removal of calculus and biofilm, individualised instruction in home oral hygiene. The foundation of any periodontal therapy.

Scaling and Root Planing (SRP)

Mechanical debridement of root surfaces below the gumline — performed under local anaesthesia. Removes bacterial deposits from periodontal pockets.

Re-evaluation After 6–8 Weeks

Clinical review: pocket depths, bleeding on probing, attachment level. Determines whether further surgical measures are required or whether implant planning may proceed.

Stability Phase of 3–6 Months

Monitored waiting period with regular SPT (Supportive Periodontal Therapy). Digital documentation of treatment outcomes via intraoral scanner and CBCT.

Clearance for Implant Planning

Once all parameters are stable: commencement of digital implant planning with CBCT, surgical guide, and navigated implant placement.

Digital Diagnostics: Determining the Right Timing

Deciding when a patient is ready for implants following periodontal treatment requires precise diagnostic data. Modern digital methods enable objective, reproducible assessment — and provide complete documentation of treatment outcomes.

CBCT / Cone Beam CT

3D visualisation of bone levels at all teeth and potential implant sites
Measurement of vertical and horizontal bone loss
Assessment of bone quality (density) for implant planning
Detection of residual infections or non-visible bone defects

Digital Periodontal Charting

Electronic recording of all pocket depths at 6 measurement points per tooth
Automatic documentation of bleeding on probing (BoP)
Progress monitoring: comparison before and after periodontal therapy
Objective clearance criteria for implant planning

Intraoral Scanner

Digital impression for implant planning without impression material
Superimposition with CBCT data for precise surgical guides
Documentation of gingival contour and soft tissue situation
Basis for navigated implant placement

Microbiological Diagnostics

Identification of specific bacterial strains (PCR test)
Assessment of individual peri-implantitis risk
Basis for targeted adjunctive antibiotic therapy if required
Recommended in aggressive periodontitis or treatment-resistant cases

Peri-implantitis Prevention Following Placement

Patients with a history of periodontitis require a more intensive aftercare protocol following implant placement than patients without periodontitis. Supportive peri-implant therapy (SPT) is the decisive factor for long-term success.

First 2 Years

SPT every 3 months: professional cleaning of implant surfaces, probing, radiographic review at 6 and 12 months. Early detection of peri-implant mucositis (reversible precursor stage).

From Year 3 Onwards

SPT every 3–6 months depending on individual risk profile. Annual radiographic review to assess peri-implant bone levels. Interval adjusted based on risk factors.

Home Oral Hygiene

Daily cleaning with interdental brushes (size matched to implant), water flosser if indicated. Avoid hard toothbrushes. Specialised implant toothbrushes for hard-to-reach areas.

Immediate Action for Symptoms

Gingival bleeding, swelling, mobility, or pressure sensation around the implant: contact your clinician immediately. Peri-implant mucositis is reversible — established peri-implantitis with bone loss is not.

Checklist: What should be clarified in advance?

Tap an item to check it off.

Häufige Fragen (FAQ)

Yes — but only after complete periodontal treatment and a stability phase of 3–6 months. Active periodontitis is a relative contraindication for implants, not an absolute one. Once the inflammation is controlled, pocket depths have normalised, and the bone is stable, implants can be placed successfully. Digital diagnostics (CBCT, intraoral scanner) help determine the right timing.

Peri-implantitis is an inflammation of the tissue surrounding an implant — the implant equivalent of periodontitis. Like periodontitis, it is caused by bacteria and leads to bone loss. The difference: implants lack periodontal fibres that act as an early-warning system. Peri-implantitis can therefore progress more rapidly than periodontitis. Patients with a history of periodontitis have an elevated risk of developing peri-implantitis.

The waiting period depends on the severity of periodontitis and the success of treatment. As a general rule, a stability phase of 3–6 months is recommended, during which pocket depths are monitored and treatment outcomes are digitally documented. In cases of severe bone loss, additional bone grafting may be necessary, which requires further healing time.

The main culprits are anaerobic gram-negative bacteria: Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia (the so-called 'red complex'), and Aggregatibacter actinomycetemcomitans. These bacteria can migrate from periodontal pockets onto implant surfaces — particularly in patients who have previously had periodontitis.

Periodontal rehabilitation encompasses all measures necessary to control periodontitis: mechanical debridement (scaling and root planing), laser therapy if indicated, oral hygiene instruction, and regular monitoring. The goal is to bring all pocket depths below 4 mm and eliminate bleeding on probing. Only once this condition is stable should implant planning begin.

Further Guides

Guide

Dental Implants – What You Should Know Beforehand

Complete overview: requirements, costs, and procedure

Guide

Periodontitis Diagnostics

How is periodontitis detected and classified?

Guide

CBCT / 3D X-Ray

Why 3D diagnostics are crucial before implant placement

Clinical Partner

Consultation at Smile4Life

For a clinical assessment of your individual situation — in Vienna, 1010.

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Medical note: The information on this page is for general educational purposes only and does not replace individual medical advice from a licensed dentist or specialist. The Institute for Implantology and Digital Dentistry Vienna is a non-profit, independent scientific platform — not a treatment facility. All content reflects current scientific literature; individual treatment decisions must always be made in consultation with a qualified dental professional.

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